Fulminant, CMV-associated, haemophagocytic syndrome following unrelated bone marrow transplantation

Bone Marrow Transplant. 1998 Dec;22(12):1219-22. doi: 10.1038/sj.bmt.1701501.

Abstract

We report a case of haemophagocytic syndrome (HPS) occurring after allogeneic bone marrow transplantation (BMT) for acute promyelocytic leukaemia (APL) in a patient in fourth complete remission (CR). Anti-cytomegalovirus (CMV) antibody (Ab) was negative in this patient before BMT. BMT was performed from an HLA-identical unrelated donor who was positive for CMV Ab. After bone marrow engraftment and haematological recovery, severe acute graft-versus-host disease (GVHD) developed. This patient was treated with methylprednisolone in addition to cyclosporin A (CsA). Acute GVHD showed partial improvement, but CMV antigenaemia was observed. Despite administration of gancyclovir and immunoglobulin, CMV antigenaemia showed no improvement and HPS developed. As no other infections or malignancies were observed, we suspect that CMV infection was the trigger for development of HPS.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Bone Marrow Transplantation / adverse effects*
  • Cyclosporine / adverse effects
  • Cyclosporine / therapeutic use
  • Cytomegalovirus Infections / drug therapy
  • Cytomegalovirus Infections / etiology
  • Female
  • Graft vs Host Disease / drug therapy
  • Graft vs Host Disease / etiology
  • Histiocytosis, Non-Langerhans-Cell / etiology*
  • Histocompatibility Testing
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Leukemia, Promyelocytic, Acute / therapy*
  • Methylprednisolone / adverse effects
  • Methylprednisolone / therapeutic use
  • Transplantation, Homologous

Substances

  • Anti-Inflammatory Agents
  • Antiviral Agents
  • Immunosuppressive Agents
  • Cyclosporine
  • Methylprednisolone